摘要目的 确(足母)趾内侧趾足底固有神经的走行、分支及其与周围筋膜组织及器官的毗邻关系,为临床上治疗神经卡压提供精确定位及相关解剖学依据.方法 自2016年12月至2019年1月,共收集了54侧福尔马林固定的足.其中50侧常规解剖,4侧制作足部断层.观察(足母)趾内侧趾足底固有神经的走行及分支情况;于第1跖趾关节处及其近侧、远侧0.5 cm处,分别测量该神经的宽度、厚度.应用足部断层解剖观察此处筋膜来源与起止.Masson染色观察跖趾关节处神经的组织变化.结果 (足母)趾内侧趾足底固有神经在近跖趾关节处走行于(足母)长屈肌腱与(足母)展肌肌腱之间偏内侧,发出(4.21±0.12)条终支,支配(足母)趾内侧半皮肤.跖趾关节处神经的宽度为(3.50±0.09) mm,与关节近段[(1.58±0.04) mm]及远段[(1.56±0.03) mm]相比,明显增加,差异有统计学意义(P＜0.05);近侧段神经厚度为(0.83±0.04)mm,远侧段为(0.82±0.03) mm,与跖趾关节处神经的厚度为(0.67±0.02) mm相比,差异有统计学意义(P＜0.05);常规解剖及足部断层观察到(足母)趾内侧趾足底固有神经浅面有一深筋膜,张于(足母)长屈肌腱腱鞘与(足母)展肌肌腱之间;Masson染色显示跖趾关节处神经外膜纤维增生明显,神经纤维束分束增多,神经束膜均增厚明显.结论 长期受压可至神经外膜及束膜增厚,其浅面的筋膜可能是造成(足母)趾内侧趾足底固有神经卡压出现(足母)趾疼痛、麻木的重要因素.

abstractsObjective To identify the routes and branches of the proper plantar digital nerves(PPDN) in the medial of the great toe and its adjoining relationship among the surrounding fascia tissues and organs,which was expected to provide accurate localization of the nerve impingement and possible relevant of anatomical basis for the treatment of nerve entrapment in clinical utility.Methods From December,2016 to January,2019,a total of 54 formalin fixed feet were collected.Fifty of them were performed conventional anatomical procedure,the other 4 were prepared with sectional anatomical technique.The seats and branches of the PPDN in the medial of the great toe were observed;The width and thickness of the nerve were measured at the first metatarpophalangeal joint(FMPJ),along with its proximal and distal sides 0.5 cm.The origin and origin of fascia were observed by foot dissection.Masson staining was used to observe the tissue changes of the nerves in the FMPJ.Results The PPDN of the medial great toe run between the flexor pollicis longus tendon and the abductor pollicis tendon at the proximal,issued (4.21±0.12) final branches.And governed the sensation of the medial half of the great toe.The width of the nerve at the FMPJ was (3.50±0.09) mm,which was significantly increased compared with that of the near [(1.58±0.04) mm] and far [(1.56± 0.03) mm] from the joint.The difference was statistically significant (P＜0.05);The thickness of the nerve in the proximal segment was (0.83±0.04) mm,and that in the distal segment was (0.82±0.03) mm.Compared with that in the FMPJ [(0.67±0.02) mm],the difference was statistically significant (P＜0.05).A deep fascia was observed on the superficial surface of the PPDN at medial great toe,which was stretched between the tendon sheath of the flexor pollicis longus tendon and the tendon of the abductor pollicis muscle.Masson staining showed obvious proliferation of nerve outer mem brane fibers at the metatarpophalangeal joint,the number of nerve fiber bundles increased,and obvious thickening of nerve fiber bundles and nerve fascia.Conclusion Long-term compression can lead to thickening of the epineurium and perineurium,and the superficial fascia is an important factor of thumb pain and numbness caused by the compression of the PPDN at medial of the great toe.